ANN ARBOR—A new University of Michigan study finds that mid-level practitioners who are trained to provide fillings do so competently and safely, performing these procedures as well as dentists.

U-M researchers reviewed the findings of 23 separate studies conducted in six industrialized countries over the past 60 years that assessed the clinical competence of non-dentists performing a limited set of "irreversible" procedures, such as simple fillings and extractions. These procedures are traditionally done only by dentists, and many dentists in the U.S. don't want this to change.

The report comes at a time when more states are debating the merits of adding dental therapists to their workforces to improve access to dental care for low-income and geographically remote populations. Dental therapists currently are only allowed to practice in two states, Alaska and Minnesota, although legislation promoting the concept has been introduced in a dozen others.

"We became interested in this topic out of concern over the large access to care gap," said lead author Elizabeth Phillips, a research associate at the U-M School of Social Work. "We heard about dental therapists and wondered why they weren't more common."

Phillips and colleague Luke Shaefer, assistant professor of social work, discovered that, for the most part, organized dentistry—the American Dental Association and state dental associations—is vehemently opposed to dental therapists, often arguing that patient safety is at stake.

This puzzled the researchers, who said that many other countries embrace the concept as a cost-effective means of expanding care.

"The more we read, the more it became clear to us that the empirical evidence is overwhelming—technical competence is simply not an issue," Shaefer said.

The researchers said they are not necessarily advocating the introduction of dental therapists. However, they do maintain that as the debate over their merits continues to intensify, clinical competence should not be a point of contention.